Active NPI
Kamilah Jackson, M.D.
- Psychiatry Physician
- New Haven, CT
National Provider Identifier
1851590822
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 58352
- Practice address
- 230 South Frontage Road
New Haven, CT 06519 - Phone
- (203) 785-2516
- NPI assigned
- Jul 11, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 58352 | GA | Primary |
Addresses
Primary practice location
230 South Frontage Road
New Haven, CT 06519
Mailing address
230 South Frontage Road
P.O. Box 207900
New Haven, CT 06520-7900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 58352 | GA | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cycare LLC | Past | Accepting new patients | |
| Cycare LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Psychiatric/Mental Health Clinical Nurse Specialist
- Bloomfield, CT
- NPI 1336150002
-
- Psychiatric/Mental Health Clinical Nurse Specialist
- Bloomfield, CT
- NPI 1871866178
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184112000000",
"number": "1851590822",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "230 SOUTH FRONTAGE ROAD",
"address_2": "P.O. BOX 207900",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065207900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "230 SOUTH FRONTAGE ROAD",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "06519",
"telephone_number": "203-785-2516"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KAMILAH",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-11",
"last_updated": "2007-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "GA",
"license": "58352",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Haven, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.